Provider Demographics
NPI:1386381127
Name:TRUE SELF THERAPY
Entity type:Organization
Organization Name:TRUE SELF THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:BASTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD, LCSW
Authorized Official - Phone:732-236-1930
Mailing Address - Street 1:14 REDWICK WAY
Mailing Address - Street 2:
Mailing Address - City:SOUTH RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08882-2611
Mailing Address - Country:US
Mailing Address - Phone:732-236-1930
Mailing Address - Fax:
Practice Address - Street 1:14 REDWICK WAY
Practice Address - Street 2:
Practice Address - City:SOUTH RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08882-2611
Practice Address - Country:US
Practice Address - Phone:732-236-1930
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-13
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1730654294OtherNPI